Characteristics and Long-Term Outcomes of Patients with Reduced, Mid-Range, and Preserved Ejection Fraction Following Hospitalization for Acute Heart Failure in a Contemporary Real World Setting - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

Israel Mazin Heart Failure Clinic, Sheba Medical Center, Israel Dov Friemark Heart Failure Clinic, Sheba Medical Center, Israel Michael Arad Heart Failure Clinic, Sheba Medical Center, Israel Yael Peled Heart Failure Clinic, Sheba Medical Center, Israel Avishay Gruper Heart Failure Clinic, Sheba Medical Center, Israel Nir Shlomo Cardiology Department, Sheba Medical Center, Israel Robert Klempfner Cardiology Department, Sheba Medical Center, Israel Rafael Kuperstein Non Invasive Cardiology Unit, Sheba Medical Center, Israel Ilan Goldenberg Cardiology Department, Sheba Medical Center, Israel

Aims: Recent ESC heart failure (HF) guidelines introduced a new mid-ranged left ventricle ejection fraction (LVEF) category. The purpose of the present study was to describe the clinical characteristics and long-term outcomes of patients hospitalized with acute HF categorized by LVEF, in large contemporary prospective tertiary center cohort.

Methods and Results: A total 7,752 patients were included in this study. Patients were divided according to the recent ESC heart failure guidelines. Patients with preserved EF (HFpEF) compared to those with mid-range EF (HFmrEF) or reduced EF (HFrEF) were older, more likely to be female, had a higher frequency of comorbidities, including hypertension, diabetes mellitus, and anemia. Kaplan-Meier survival analysis (Figure) showed increased mortality rates at 1-and 8-years of follow-up in both the HFmrEF (24% and 48%, respectively) and HFrEF (25% and 47%, respectively) groups, as compared with the HFpEF group (22% and 41%, respectively; log-rank p-value =0.007 for the overall difference during follow-up). Consistently, multivariate analysis showed patients with HFmrEF experienced a significant higher risk for all-cause mortality (HR= 1.24, p=0.04) and HF or death (HR= 1.2, p=0.02) compared to the HFpEF group, and a similar risk to the HFrEF group. Systemic pulmonary artery pressure (SPAP) was an independent predictor for long-term mortality among all LVEF subgroups (HR 1.43, p<0.001).

Conclusion: Our findings suggest that acute HF patients with HFmrEF group have increased risk for long–term mortality and repeated HF hospitalization that is similar to those with HFrEF. Elevated SPAP is a powerful predictor for adverse long-term outcomes following hospitalization for acute HF.